MEMORIAL HALL SCHOOL
5400 Mitchelldale, Ste. A-1 Houston, Texas 77092
Ph. (713) 688-5566 Fax (713) 956-9751
SUMMER SCHOOL APPLICATION
June 11 - August 2, 2012 Monday - Thursday
Grades 6-12
DATE OF APPLICATION______________
MALE ______ FEMALE ________ INTERNATIONAL STUDENT ____Yes ____No
STUDENT NAME_________________________________________ AGE ______GRADE___________
STUDENT EMAIL_____________________________________________________________________
CURRENT ADDRESS ______________________________CITY/ST._____________ZIP____________
BIRTHDATE _________________ PLACE OF BIRTH _____________________SS#_______________
MOTHER/GUARDIAN'S NAME _________________________________________________________
HOME PHONE (______)_______________________ WORK PHONE (_____)_____________________
MOTHER/GUARDIAN'S OCCUPATION ____________________EMPLOYER___________________
PAGER / CELLULAR/ CAR PHONE/ OTHER (_____)________________________________________
EMAIL ADDRESS______________________________________________________________________
FATHER/GUARDIAN'S NAME __________________________________________________________
HOME PHONE (______)______________________ WORK PHONE (_____)_____________________
FATHER/GUARDIAN'S OCCUPATION ___________________EMPLOYER_____________________
PAGER / CELLULAR / CAR PHONE / OTHER (_____)_______________________________________
STUDENT LIVES WITH _____________________________ RELATIONSHIP____________________
ADDRESS ____________________________________________ CITY __________________________
STATE ________________________________ ZIP CODE _____________________________________
FAX#________________________________________________________________________________
______________________________________________________WILL BE RESPONSIBLE FOR
PAYING TUITION FOR THIS STUDENT.
BILLING ADDRESS _____________________________________ CITY _________________________
STATE _____________________________________ ZIP CODE ________________________________
BILLING PHONE NUMBER _(_____)_______________________________________________________
STUDENT WAS IN __________ GRADE AT _________________________________ 2010-2011
School
STUDENT PLANS TO ATTEND ________GRADE AT __________________________2011-2012
School
REASONS FOR ATTENDING SUMMER SCHOOL________________________________________
___________________________________________________________________________________
LIST SPECIFIC SUBJECTS NEEDED:
___________________________________ _______________ ___________________________
___________________________________ _______________ ____________________________
___________________________________ _______________ ____________________________
___________________________________ _______________ ____________________________
SUBJECT HOUR TEACHER
(FOR OFFICE USE)
Memorial Hall is accredited by the Southern Association of Colleges and Private Schools and is a member of the Southern Association of Independent Schools. A 2011-2012 Official Transcript for High School Students is required from the last school attended. Students enrolling for summer school not presently enrolled in Memorial Hall need to bring a letter of approval from their counselor/school stating credit will be given for courses completed.
